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Why Is A Transesophageal Echocardiogram Performed

by Lyndon Langley
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Why Is A Transesophageal Echocardiogram Performed

Why Is A Transesophageal Echocardiogram Performed

An echocardiogram (echo) can be an invaluable tool for diagnosing heart conditions and other medical problems. It uses sound waves to create moving images of body structures like your heart. In general, echoes are created by using high-pitched sound waves that bounce off internal organs and return to a probe on the outside of your body. The sounds then travel through your skin and into your ears where they’re picked up by a microphone in the machine. An image processor translates this data into pictures. Sometimes doctors use contrast agents to help them see certain areas better. These agents have tiny bubbles attached to them that block light so they appear dark gray against all the bright background tissue.
Transthoracic echocardiograms (TTEs) are usually taken at rest while you lie down with your chest exposed. Doctors insert a small wand transducer over your breastbone and move it around until they’ve got a good view of the heart and major vessels. They also take measurements and record important information like the thickness of your heart muscle and valve sizes. Your doctor will probably do a series of these tests throughout your life as part of a routine checkup.
Transesophageal echocardiograms (TEEs) are more complex than TTEs because they require inserting a long tube with a special scope inside your mouth and sliding it down your throat toward your stomach. This allows your doctor to get a closer look at your heart and major blood vessels without having to expose your chest. While a TEE gives you a lot of information, sometimes it doesn’t provide enough detail. That’s why some people undergo additional testing called a TEE plus. In TEE plus, someone swallows a capsule containing a radio-opaque dye to give your doctor a clearer picture. A TEE isn’t recommended for pregnant women or patients who have difficulty swallowing.
Doctors usually perform a TEE if they don’t believe what they find during a standard echo. A TEE can confirm diagnoses made with a TTE or help determine whether further testing is necessary. For example, a TEE can show aortic regurgitation, which means blood leaking out of one of your heart’s four chambers, instead of being pushed forward by your heart muscles. If you’ve been diagnosed with aortic regurgitation after a TTE, a follow-up TEE might reveal milder degrees of leakage that the first test missed.
A TEE is also used to diagnose infective endocarditis, a serious disease caused by bacteria or fungi growing on your heart’s inner lining. Bacteria enter your bloodstream and attach themselves to proteins in your cells. When that happens, white blood cells go to fight those invaders. But when they get there, they attack your healthy cells too. The result is inflammation, scarring and eventually holes in your heart’s protective lining. People with artificial hearts often develop endocarditis because their hearts aren’t pumping well, allowing infected fluid to build up near the damaged area of the heart. Endocarditis can lead to heart failure quickly, making treatment essential.
Your doctor may want to order a TEE even if he thinks everything looks okay during a TTE. He may suspect valvular stenosis, which occurs when your heart’s valves become narrowed. Or he may notice a leaky mitral valve, which leads to inadequate blood flow. A TEE can confirm these suspicions.
What Happens During A Transthoracic Echo?
First, let’s talk about transthoracic echocardiography. As we mentioned earlier, this type of echo is performed when your doctor inserts a small transducer over your breast bone and moves it back and forth along your torso. Usually, they’ll start at your neck and work downward toward your abdomen. Once they reach your lower abdomen, your doctor will slide a second transducer under your ribcage and take another set of pictures showing the upper half of your heart. After finishing the scan of your entire heart, they’ll move upward again and finish taking pictures of your chest cavity. Then they’ll move both transducers out of the way, leaving just your chest open for examination.
During a typical TTE procedure, your doctor will place a stethoscope underneath your breastbone and listen to your heartbeat. They’ll then ask you to breathe deeply several times to make sure you’re calm before starting the exam. Next, they’ll put gel over your face, hold your chin firmly and slowly tilt your head backward. This positions your chest opening above your sternum, the bottom portion of your rib cage. They’ll then slip a plastic tunnel over your nose and mouth and fasten it to your gown. This keeps your shoulders relaxed but still lets you breathe normally. Finally, they’ll plug your nostrils and press a button on a control panel. This activates the ultrasound beam that’s placed directly over your chest.
The ultrasound sends sound waves deep into your body. Echoes bouncing back from different parts of your body are captured by the machine and converted into electronic signals. The computer interprets these signals and creates an image based on the size, shape and position of your various body tissues. Most machines display 2D images, though newer ones produce 3D models.
Once your doctor has finished looking at your heart, they may decide to add a third transducer at the top of your chest. This helps them examine the arteries leading to your heart and the left side of your heart. They may also choose to add a fourth transducer to the right side of your chest to look at the veins returning blood from your heart. Some TTEs include a fifth transducer aimed at your abdomen to look at the liver. Other times, they may add a sixth transducer to look at the kidneys.
In addition to viewing your heart, a TTE provides many useful diagnostic tools including measuring the diameter of your heart chambers, evaluating the thickness of your myocardium, counting the number of heart beats per minute and detecting abnormal wall motion.

How Does A TEE Differ From A TTE?
Now that you know what a TTE is, it should be easier to understand what makes a TEE different. First, a TEE requires putting a flexible tube with a scopic lens into your esophagus, which is the tubelike passageway between your throat and stomach. Because of its proximity to air, food and drink, the esophagus contains acid that could interfere with the results. So your doctor puts a topical spray of liquid lidocaine onto the roof of your mouth to numb any discomfort. Then they gently stick the tip of the tube into your mouth while holding your tongue down to keep it from blocking the view.
Next, they turn on the TEE machine and carefully guide the tube down your throat toward your stomach, stopping every few feet to adjust the angle of the scope. To ensure proper placement, an attending nurse watches the screen closely while guiding the scope with her hands. At each stop, she marks the spot with a pen. If the scope gets misaligned, your doctor can change the direction of the ultrasound beam manually.
Because the TEE takes longer to complete than a TTE, most hospitals schedule two separate appointments — one for the TTE and another for the TEE. During the TTE session, you’ll receive intravenous sedation to make you comfortable. Sedatives reduce anxiety and allow you to relax so you won’t feel pain during the procedure. Since you’ll only be awake for the initial TTE session, you shouldn’t experience any memory loss afterward.
If you choose to receive a TEE, the process is similar except you’ll spend the day recovering from anesthesia from a local hospital rather than a specialized facility. Before going home, you’ll meet with a speech therapist who will teach you how to say words such as “stop” and “start.” She’ll also explain common terms like “epi,” “systole” and “diastole” to you.
After the procedure, you’ll stay in bed for 24 hours to avoid straining the stitches in your wound. You may experience soreness or nausea for three days. Taking aspirin or ibuprofen relieves symptoms. Although rare, bleeding can occur after either procedure. Tell your doctor immediately if you see any signs of bruising or red streaks in your mouth, vomit blood or have bloody bowel movements.
Next time we’ll learn what exactly happens during a TEE, and find out why a TEE is sometimes referred to as a TOE.
The term transthoracic refers to the fact that the ultrasound beam travels through your body horizontally from front to back. Transesophageal describes the method used to take pictures of your heart. Esophagus means that the beam travels down your esophagus toward your stomach.

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